Golden Alex B, Hellenbrand William E
Children's Hospital of New York, New York Presbyterian Hospital, Columbia Campus, New York, USA.
Catheter Cardiovasc Interv. 2007 Feb 1;69(2):289-99. doi: 10.1002/ccd.21009.
Coarctation of the aorta may present in infants, children, or adults, and it requires treatment to prevent serious morbidity and mortality. Recent advances in equipment and a growing collective experience have made placement of balloon-expandable stents a safe and effective alternative to surgery or angioplasty in a growing range of patients. This review seeks to provide a working aid for stenting of coarctation of the aorta, based on the techniques and technical considerations in practice at our institution. Between 1989 and 2005, the Congenital Cardiovascular Interventional Study Consortium (CCISC), a consortium of 17 centers, of which our institution is the largest contributor, performed 588 stent placements for coarctation of the aorta. Of the 588 procedures, 580 (98.6%) were successful, as defined by reduction of the gradient to less than 20 mm Hg or increase of the ratio of the diameter of the coarctation area (CoA) to the diameter of the descending aorta (DAo) to at least 0.8. There were a total of 84 complications occurring in 69/588 (11.7%) cases. The most common significant complications were femoral access vessel related 15/588 (2.6%), aneurysm formation 13/588 (2.2%), aortic dissection 9/588 (1.5%), and cerebrovascular accident 6/588 (1.0%). There were two procedure-related deaths (0.3%) recorded in the 16-year period. Many of these significant complications occurred in the same patients. Balloon-expandable stents should be considered a safe and very effective treatment modality in a significant subset of patients with coarctation of the aorta.
主动脉缩窄可出现在婴儿、儿童或成人中，需要进行治疗以预防严重的发病和死亡。设备的最新进展以及不断积累的经验使得在越来越多的患者中，植入球囊扩张支架成为手术或血管成形术的一种安全有效的替代方法。本综述旨在根据我们机构实际应用的技术和技术考量，为主动脉缩窄的支架置入提供实用帮助。1989年至2005年期间，先天性心血管介入研究联盟（CCISC），一个由17个中心组成的联盟，其中我们机构是最大的贡献者，对主动脉缩窄进行了588次支架置入。在这588例手术中，580例（98.6%）成功，成功定义为压差降至小于20 mmHg或缩窄区域（CoA）直径与降主动脉（DAo）直径之比增加至至少0.8。共有84例并发症发生在69/588（11.7%）的病例中。最常见的严重并发症是与股动脉入路血管相关的15/588（2.6%）、动脉瘤形成13/588（2.2%）、主动脉夹层9/588（1.5%）和脑血管意外6/588（1.0%）。在这16年期间记录了两例与手术相关的死亡（0.3%）。许多这些严重并发症发生在同一患者身上。对于相当一部分主动脉缩窄患者，球囊扩张支架应被视为一种安全且非常有效的治疗方式。
